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High Tibial Osteotomy

High Tibial Osteotomy


High Tibial Osteotomy (HTO) is a surgical procedure aimed at alleviating pain and improving function in patients with knee osteoarthritis, particularly those with medial compartment osteoarthritis. This blog delves into the intricacies of HTO, supported by international research and clinical facts.

What is High Tibial Osteotomy?

High Tibial Osteotomy involves the surgical realignment of the knee joint to redistribute weight-bearing forces away from the damaged or arthritic area to a healthier part of the knee. This procedure is commonly recommended for younger, active patients who are not yet suitable candidates for total knee replacement.

Indications for High Tibial Osteotomy

HTO is typically indicated for patients with the following conditions:

  • Medial compartment osteoarthritis
  • Varus deformity (bow-leggedness)
  • Pain localized to the medial (inner) side of the knee
  • Active lifestyle with a desire to delay total knee replacement

The Procedure

Preoperative Planning

Preoperative planning is crucial for the success of High Tibial Osteotomy. This involves:

  • Detailed clinical evaluation
  • Imaging studies including X-rays, MRI, and CT scans
  • Assessment of limb alignment and deformity

Surgical Technique

The surgical technique for HTO can vary, but it generally involves the following steps:

  1. Incision: An incision is made along the medial side of the knee.
  2. Bone Cut: A controlled cut is made in the tibia (shinbone) just below the knee joint.
  3. Realignment: The bone is realigned to correct the deformity, and a wedge of bone may be added or removed.
  4. Fixation: The bone is stabilized using plates and screws to maintain the new alignment.

Postoperative Care

Postoperative care is critical for successful recovery and includes:

  • Pain management
  • Physical therapy
  • Gradual weight-bearing as recommended by the surgeon
  • Regular follow-up visits for monitoring healing and alignment

Benefits of High Tibial Osteotomy

HTO offers several benefits:

  • Pain relief: By redistributing weight, HTO reduces pain in the arthritic part of the knee.
  • Improved function: Patients often experience better knee function and mobility.
  • Delay in knee replacement: HTO can delay the need for total knee replacement, making it an attractive option for younger patients.

International Research on High Tibial Osteotomy

Success Rates and Long-term Outcomes

A study published in the Journal of Bone and Joint Surgery found that HTO has a success rate of over 80% at 10 years postoperatively, with many patients reporting significant pain relief and improved function.

Comparison with Total Knee Replacement

Research from the American Academy of Orthopaedic Surgeons indicates that while total knee replacement may provide more immediate pain relief, HTO allows patients to maintain a higher level of activity and may result in more natural knee movement.

Advancements in Technique

International research has led to advancements in HTO techniques, including the use of computer-assisted surgery and patient-specific instrumentation, which have improved the accuracy of bone cuts and alignment.


A study in the Journal of Orthopaedic Research highlights that HTO is a cost-effective alternative to total knee replacement, especially in younger patients, due to its lower initial costs and the potential to delay more extensive surgery.

High Tibial Osteotomy is a valuable surgical option for patients with medial compartment osteoarthritis, offering pain relief, improved function, and the potential to delay knee replacement. With advancements in surgical techniques and a growing body of international research supporting its efficacy, HTO continues to be a cornerstone in the management of knee osteoarthritis. If you are considering HTO, consult with your orthopedic surgeon to discuss the best treatment plan tailored to your specific needs.

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